AUTHOR=Kawasaki Shinji , Nishimura Yukihide , Kouda Ken , Umemoto Yasunori , Kinoshita Tokio , Hashizaki Takamasa , Kawanishi Makoto , Nakamura Taro , Tajima Fumihiro 

TITLE=Follow-Up Study of Subdermal Low-Echoic Lesions in the Ischial Region in Wheelchair Users With Spinal Cord Injuries

JOURNAL=Frontiers in Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.848338

DOI=10.3389/fmed.2022.848338

ISSN=2296-858X

ABSTRACT=Objective: To follow up subjects with spinal cord injuries with subdermal low-echoic lesions in the ischial region for abnormalities after 1 year. Design: A retrospective cohort study. Setting: A Japanese rehabilitation center. Participants: Patients with chronic spinal cord injuries and subdermal low-echoic lesions who underwent routine inspection and palpation examinations (n=7). Interventions: Education on pressure injury and instruction on pressure relief and seating was provided and the patients were followed up for abnormalities after 1 year. Self-reports were obtained on wheelchair sitting time, and interface pressure was recorded while the subjects were seated in the wheelchair. Interface pressure measurements at the bilateral ischial regions were recorded with a force-sensitive application pressure mapping system. Outcome measures: The primary outcome was the presence of subdermal low-echoic lesions in the bilateral ischial regions on ultrasonography at the 1-year follow-up examination. Secondary outcomes included wheelchair sitting time and interface pressure in the bilateral ischial regions. Results: Of the 10 areas that showed subdermal low-echoic lesions on ultrasonography, nine had improved after 1 year. One area that did not improve was an open wound. At the follow-up examination, the pressure duration was reduced in all subjects, and the interface pressure could be reduced in 5/7. Conclusions: This is the first study to follow up subdermal low-echoic lesions in the ischial region by ultrasonography in patients with spinal cord injuries. The low-echoic lesions improved within 1 year by reducing the pressure duration and interface pressure. Pressure injury prevention in people with spinal cord injuries relies on the early detection of skin abnormalities, and education and instruction to change self-management behaviors are recommended.